Focus on health is the key to welfare of humanity

Dr Margaret Chan
Director-General of the World Health Organization

Address at the Economic and Social Council 2009 High-level Segment
Geneva, Switzerland

6 July 2009

Madam President, Secretary-General of the United Nations, excellencies, honourable ministers, distinguished delegates, ladies and gentlemen,

We are meeting at a time when the world faces multiple crises on multiple fronts. In a sense, this is nothing new. Floods, droughts, famine, war, pestilence, plagues, and economic booms and busts are familiar companions in the up-and-down cycle of human history.

But today’s crises are different. They have some unprecedented dimensions. They are revealing, in ominous ways, what it means to live in a closely interdependent and interconnected world.

They are revealing some fundamental flaws in the policies and systems that govern the way nations and their populations interact internationally. Greed seeded the financial crisis, which sprang out of control as corporate governance and risk management failed at every level of the system.

Climate change is the price we will now inevitably pay for short-sighted policies. Fuelling the world’s economic growth took precedence over safeguarding the planet’s ecological health.

Today, we make such mistakes at great peril.

The fates of all nations are bound together as never before. Mistakes made in one part of the world spread very quickly throughout the international system.

As the economists tell us, the financial crisis is unprecedented because it occurs at a time of radically increased interdependence among nations. The consequences have been highly contagious, moving quickly from one country to another, and from one sector of the economy to many others.

As we are seeing, the consequences of flawed polices are also profoundly unfair. Even countries that managed their economies well and did not take excessive risks are suffering from the economic downturn. Likewise, the countries that contributed least to greenhouse gas emissions will be the first and hardest hit by climate change.

The different sectors of government are also bound together as never before. Policy spheres are no longer distinct. A short-sighted policy in one sector can rapidly have adverse effects on many others, and most especially on health.

Global trends, such as the industrialization of food production and the globalization of its marketing and distribution, help feed the world. But these trends have also contributed to a public health crisis.

I am referring to the dramatic rise of diet-related chronic diseases, especially in the developing world. This trend has, in turn, been exacerbated by the financial crisis and the food crisis.

When money is tight, the first things that drop out of the diet are usually the healthy foods, like fruits, vegetables, and lean sources of protein, which are nearly always more expensive.

Processed foods, rich in fats and sugar and low in essential nutrients, become the cheapest way to fill a hungry stomach. This is the type of diet linked to the rise of chronic diseases.

As this century progresses, more and more crises are likely to be global in nature, with global causes, and with global consequences that are unfairly biased against countries and populations least able to cope.

Let me remind you of a bitter irony. All this is happening at a time when the international community is engaged in the most ambitious drive in history to reduce poverty and reduce the great gaps in health outcomes.

Ladies and gentlemen,

We are in a mess. The financial crisis hit the world like a sudden jolt, and it hit the world where it hurts the most: money.

This is not the kind of crisis, like an earthquake or a flood, where some fortunate, unaffected parts of the world can generously assist those who are suffering. All countries, rich and poor, north and south, are affected. But this is a crisis that will hurt the poor the hardest and the longest.

Because of the financial crisis, people in rich nations are losing their jobs, their homes, and their savings, and this is tragic. In developing countries, they will lose their lives.

Climate change is a gradual and now inevitable event, but the effects of more frequent and more extreme weather events will be abrupt and acutely felt. Again, the need for humanitarian assistance, for victims of floods, droughts, storms, and famine, will grow at a time when all countries are stressed, to one degree or another, by climate change. Just a decade from now, crop yields in some parts of Africa are expected to drop by 50%. Among Africa’s poor, 90% depend on agriculture for their livelihoods. There is no surplus. There is no coping capacity. There is no cushion to absorb the shocks.

Already, around 1 billion people are living on the margins of survival. It does not take much to push them over the brink.

And now we have another great global contagion to contend with. Last month, the World Health Organization announced the start of the 2009 influenza pandemic. A pandemic which currently shows moderate severity in affluent countries could have a devastating impact in the developing world.

The gaps and inequities that we are all trying so hard to address are likely to grow even greater.

Crises like the food crisis, the financial crisis, climate change, and pandemic influenza will deepen the misery and worsen the health of people and countries that already suffer the most.

Too many models for development assumed that living conditions and health status would somehow automatically improve when countries modernized, liberalized their trade, and experienced rapid economic growth.

But this did not happen. Instead, differences, within and between countries, in income levels, in opportunities, and in health status, are greater today than at any time in recent history.

Globalization has not turned out to be the rising tide that lifts all boats. Instead, wealth has been created and spread in waves that lift the bigger boats but swamp or sink many smaller ones.

This is the lesson that experts and analysts in sectors with far more clout than health now see, loud and clear, because of the financial crisis. We are now hearing calls, from multiple world leaders, for transformational changes in the polices that govern the way the world works.

The international systems need to be re-engineered to incorporate a moral dimension. They need to be transformed by policies that respond to the concerns and values of society.

Ladies and gentlemen,

Let me conclude by briefly mentioning what I believe are some of the greatest challenges facing health development today.

First, we must maintain the current momentum for better health. Special attention must be given to the Millennium Development Goals We simply cannot afford to stumble, or slow down for a moment. These crises mean that the price of failure just keeps getting higher.

Second, the strengthening of health systems must stay at the top of the global health agenda. Weak health systems ultimately blunt the power of all our noble efforts and ambitious goals.

Third, we must make fairness, as articulated by the values, principles and approaches of primary health care, our overarching goal.

And finally, we must make the prevention and control of chronic noncommunicable diseases and the improvement of maternal health top priorities on the development agenda.

Both are entirely doable undertakings. Both are part of the agenda for strengthening health systems and revitalizing primary health care. Both are fully ready and mature areas for efficient interventions with a huge return. Both are begging for more attention.

I have a final remark, and a question. In a sense, the Millennium Declaration and its Goals operate as a corrective strategy. They aim to give this lopsided world a greater degree of balance, in opportunities, in income levels, and in health.

They aim to compensate for international systems that create benefits, yet have no rules that guarantee the fair distribution of these benefits.

They give us our best chance ever to introduce greater fairness in this world. But the Millennium Development Goals do not address the root causes of these inequities. The root causes reside in flawed policies.

Here is my question: When will the world finally see what most of us in public health regard as self-evident?

It is this. A focus on health as a worthy pursuit for its own sake is the surest route to that moral dimension that is so sadly lacking in international systems of governance. It is the surest route to a value system that puts the welfare of humanity at its heart.

Thank you.